Association Between Treatment Facility Volume, Therapy Types, and Overall Survival in Patients With Stage IIIA Non–Small Cell Lung Cancer

Abstract

Background: There is significant heterogeneity in the treatment of stage IIIA non–small cell lung cancer (NSCLC). This study evaluated the therapeutic and survival disparities in patients with stage IIIA NSCLC based on the facility volume using the National Cancer Database. Methods: Patients with stage IIIA NSCLC diagnosed from 2004 through 2015 were included. Facilities were classified by tertiles based on mean patients treated per year, with low-volume facilities treating ≤8 patients, intermediate-volume treating 9 to 14 patients, and high-volume treating ≥15 patients. Cox multivariate analysis was used to determine the volume–outcome relationship. Results: Analysis included 83,673 patients treated at 1,319 facilities. Compared with patients treated at low-volume facilities, those treated at high-volume centers were more likely to be treated with surgical (25% vs 18%) and trimodality (12% vs 9%) therapies. In multivariate analysis, facility volume was independently associated with all-cause mortality (P<.0001). Median overall survival by facility volume was 15, 16, and 19 months for low-, intermediate-, and high-volume facilities, respectively (P<.001). Compared with patients treated at high-volume facilities, those treated at intermediate- and low-volume facilities had a significantly higher risk of death (hazard ratio, 1.09 [95% CI, 1.07–1.11] and 1.11 [95% CI, 1.09–1.13], respectively). Conclusions: Patients treated for stage IIIA NSCLC at high-volume facilities were more likely to receive surgical and trimodality therapies and had a significant improvement in survival.

Disparities in guideline-concordant treatment for node-positive, non–small cell lung cancer following surgery

“…29,30 related to race and socioeconomic status. [28][29][30]33,34 Furthermore, we found that similar to other studies examining disparities in aspects of lung cancer care, there are significant differences in delivery of adjuvant therapy in relationship to geographic region, particularly in the west and south, which is likely related to access to care, density of providers, socioeconomic disparities, or rural versus urban settings. 7,14,33 Addressing disparities in cancer care is complex.…”

Radiotherapy: An Alternative to Surgery

“…This is well illustrated by a recent paper including more than 83,000 patients presenting a stage III NSCLC treated in 1319 facilities. Those treated in a high volume centre (more than 15 patients) were more likely to have surgery or a trimodality and had significantly a lower risk of death [36]. This is one reason to look more to randomised trials to answer the question.…”

Timeliness of cancer care in a regional Victorian health service: A comparison of high‐volume (Lung) and low‐volume (oesophagogastric) tumour streams

“…While studies on the timeliness of access to treatment in OG cancers are scarce, one study found that a delayed surgical resection has no impact on long‐term survival 17 . However, treatment at larger treatment centres has been shown to culminate in better survival for both lung 18,19 and OG 20‐22 cancer patients. This evidence may suggest that the larger treatment centres have more streamlined care services than smaller centres, highlighting the benefits of service centralisation 4 .…”